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Transmitted antiretroviral drug resistance in New York State, 2006-2008: results from a new surveillance system.

Readhead AC, Gordon DE, Wang Z, Anderson BJ, Brousseau KS, Kouznetsova MA, Forgione LA, Smith LC, Torian LV - PLoS ONE (2012)

Bottom Line: The proportion with mutations associated with any antiretroviral agent in the NNRTI, NRTI or PI class was 6.3% (5.5%-7.0%), 4.3% (3.6%-4.9%) and 2.9% (2.4%-3.4%), respectively.TDR did not increase significantly over time (p for trend = 0.204).TDR to EFV+TDF+FTC and LPV/r+TDF+FTC regimens was 7.1% (6.3%-7.9%) and 1.4% (1.0%-1.8%), respectively.

View Article: PubMed Central - PubMed

Affiliation: The New York City Department of Health and Mental Hygiene, HIV Epidemiology and Field Services Program, New York, New York, United States of America.

ABSTRACT

Background: HIV transmitted drug resistance (TDR) is a public health concern because it has the potential to compromise antiretroviral therapy (ART) at the population level. In New York State, high prevalence of TDR in a local cohort and a multiclass resistant case cluster led to the development and implementation of a statewide resistance surveillance system.

Methodology: We conducted a cross-sectional analysis of the 13,109 cases of HIV infection that were newly diagnosed and reported in New York State between 2006 and 2008, including 4,155 with HIV genotypes drawn within 3 months of initial diagnosis and electronically reported to the new resistance surveillance system. We assessed compliance with DHHS recommendations for genotypic resistance testing and estimated TDR among new HIV diagnoses.

Principal findings: Of 13,109 new HIV diagnoses, 9,785 (75%) had laboratory evidence of utilization of HIV-related medical care, and 4,155 (43%) had a genotype performed within 3 months of initial diagnosis. Of these, 11.2% (95% confidence interval [CI], 10.2%-12.1%) had any evidence of TDR. The proportion with mutations associated with any antiretroviral agent in the NNRTI, NRTI or PI class was 6.3% (5.5%-7.0%), 4.3% (3.6%-4.9%) and 2.9% (2.4%-3.4%), respectively. Multiclass resistance was observed in <1%. TDR did not increase significantly over time (p for trend = 0.204). Men who have sex with men were not more likely to have TDR than persons with heterosexual risk factor (OR 1.0 (0.77-1.30)). TDR to EFV+TDF+FTC and LPV/r+TDF+FTC regimens was 7.1% (6.3%-7.9%) and 1.4% (1.0%-1.8%), respectively.

Conclusions/significance: TDR appears to be evenly distributed and stable among new HIV diagnoses in New York State; multiclass TDR is rare. Less than half of new diagnoses initiating care received a genotype per DHHS guidelines.

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Related in: MedlinePlus

Proportion of cases receiving genotype within 3 months of diagnosis, with adjustment for completeness of reporting.
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pone-0040533-g001: Proportion of cases receiving genotype within 3 months of diagnosis, with adjustment for completeness of reporting.

Mentions: Integrating resistance data into the existing surveillance system was logistically and technically challenging. Laboratories certified by NYSDOH to perform resistance testing were required to report nucleotide sequences beginning on June 1, 2005. However, laboratories acquired full capacity to report resistance data at different times after the regulations were enacted, which meant that much of the data was reported retrospectively. Laboratories were required to resubmit when incomplete data were identified; however, some laboratories were not able to do so. Completeness of laboratory reporting was estimated by comparing self-reported laboratory testing logs to received data transmissions. Completeness was estimated to be 82% in 2006, 89% in 2007, and 98% in 2008. Adjusting for completeness, the proportion of persons with new diagnoses with initial resistance tests increased from 29% in 2006 to 39% in 2008 (p<.0001) (Figure 1). Incomplete data in key fields (e.g. name and date of birth) affected the matching of some reports to the surveillance registry. However, the proportion of resistance tests that could be matched was similar to other reportable tests.


Transmitted antiretroviral drug resistance in New York State, 2006-2008: results from a new surveillance system.

Readhead AC, Gordon DE, Wang Z, Anderson BJ, Brousseau KS, Kouznetsova MA, Forgione LA, Smith LC, Torian LV - PLoS ONE (2012)

Proportion of cases receiving genotype within 3 months of diagnosis, with adjustment for completeness of reporting.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3412856&req=5

pone-0040533-g001: Proportion of cases receiving genotype within 3 months of diagnosis, with adjustment for completeness of reporting.
Mentions: Integrating resistance data into the existing surveillance system was logistically and technically challenging. Laboratories certified by NYSDOH to perform resistance testing were required to report nucleotide sequences beginning on June 1, 2005. However, laboratories acquired full capacity to report resistance data at different times after the regulations were enacted, which meant that much of the data was reported retrospectively. Laboratories were required to resubmit when incomplete data were identified; however, some laboratories were not able to do so. Completeness of laboratory reporting was estimated by comparing self-reported laboratory testing logs to received data transmissions. Completeness was estimated to be 82% in 2006, 89% in 2007, and 98% in 2008. Adjusting for completeness, the proportion of persons with new diagnoses with initial resistance tests increased from 29% in 2006 to 39% in 2008 (p<.0001) (Figure 1). Incomplete data in key fields (e.g. name and date of birth) affected the matching of some reports to the surveillance registry. However, the proportion of resistance tests that could be matched was similar to other reportable tests.

Bottom Line: The proportion with mutations associated with any antiretroviral agent in the NNRTI, NRTI or PI class was 6.3% (5.5%-7.0%), 4.3% (3.6%-4.9%) and 2.9% (2.4%-3.4%), respectively.TDR did not increase significantly over time (p for trend = 0.204).TDR to EFV+TDF+FTC and LPV/r+TDF+FTC regimens was 7.1% (6.3%-7.9%) and 1.4% (1.0%-1.8%), respectively.

View Article: PubMed Central - PubMed

Affiliation: The New York City Department of Health and Mental Hygiene, HIV Epidemiology and Field Services Program, New York, New York, United States of America.

ABSTRACT

Background: HIV transmitted drug resistance (TDR) is a public health concern because it has the potential to compromise antiretroviral therapy (ART) at the population level. In New York State, high prevalence of TDR in a local cohort and a multiclass resistant case cluster led to the development and implementation of a statewide resistance surveillance system.

Methodology: We conducted a cross-sectional analysis of the 13,109 cases of HIV infection that were newly diagnosed and reported in New York State between 2006 and 2008, including 4,155 with HIV genotypes drawn within 3 months of initial diagnosis and electronically reported to the new resistance surveillance system. We assessed compliance with DHHS recommendations for genotypic resistance testing and estimated TDR among new HIV diagnoses.

Principal findings: Of 13,109 new HIV diagnoses, 9,785 (75%) had laboratory evidence of utilization of HIV-related medical care, and 4,155 (43%) had a genotype performed within 3 months of initial diagnosis. Of these, 11.2% (95% confidence interval [CI], 10.2%-12.1%) had any evidence of TDR. The proportion with mutations associated with any antiretroviral agent in the NNRTI, NRTI or PI class was 6.3% (5.5%-7.0%), 4.3% (3.6%-4.9%) and 2.9% (2.4%-3.4%), respectively. Multiclass resistance was observed in <1%. TDR did not increase significantly over time (p for trend = 0.204). Men who have sex with men were not more likely to have TDR than persons with heterosexual risk factor (OR 1.0 (0.77-1.30)). TDR to EFV+TDF+FTC and LPV/r+TDF+FTC regimens was 7.1% (6.3%-7.9%) and 1.4% (1.0%-1.8%), respectively.

Conclusions/significance: TDR appears to be evenly distributed and stable among new HIV diagnoses in New York State; multiclass TDR is rare. Less than half of new diagnoses initiating care received a genotype per DHHS guidelines.

Show MeSH
Related in: MedlinePlus